Quantifying alcohol-attributable disability-adjusted life years to others than the drinker in Aotearoa/New Zealand: A modelling study based on administrative data.

BACKGROUND AND AIMS: Quantifying the health burden of alcohol has largely focused upon harm to drinkers, which is an underestimate. There is a growing literature on alcohol's harm to others (HTO), but it lacks the systematic transfer of HTO into a comparative risk assessment framework. This study calculated disability-adjusted life years (DALYs) for fetal alcohol spectrum disorder (FASD), interpersonal violence and traffic injury due to another's drinking. DESIGN: This study is a disease burden analysis, using modelling of DALYs for New Zealand in 2018. SETTING AND PARTICIPANTS: The study took place among the Aotearoa/New Zealand population in 2018. MEASUREMENTS: The involvement of others' drinking was obtained from prevalence, alcohol-attributable fraction studies and administrative data. Disability weights (DW) for FASD were adapted from fetal alcohol syndrome (FAS) weights using a Beta-Pert probability distribution; for interpersonal injury, DWs used hospital events linked with injury compensation; for traffic injury, DWs used hospital events. Populations were stratified by ethnicity, age group and gender. A descriptive comparison was made with a previous estimate of DALYs for drinkers. FINDINGS: In 2018, 78 277 healthy life years were lost in Aotearoa/New Zealand due to alcohol's HTO. The main contributor (90.3%) was FASD, then traffic crashes (6.3%) and interpersonal violence (3.4%). The indigenous population, Maori, was impacted at a higher rate (DALYs among Maori were 25 per 1000 population; among non-Maori 15 per 1000 population). The burden of HTO was greater than that to drinkers (DALYs HTO = 78 277; DALYs drinkers = 60 174). CONCLUSIONS: Disability from fetal alcohol spectrum disorder (FASD) appears to be a major contributor to alcohol's harm to others in Aotearoa/New Zealand. Taking FASD into account, the health burden of harm to others is larger than harm to the drinker in Aotearoa/New Zealand, and ethnicity differences show inequity in harm to others. Quantification of the burden of harm informs the value of implementing effective alcohol policies and should include the full range of harms.

Generating political priority for alcohol policy reform: A framework to guide advocacy and research.

INTRODUCTION: While effective policies exist to reduce alcohol-related harm, political will to enact them is low in many jurisdictions. We aimed to identify key barriers and strategies for strengthening political priority for alcohol policy reform. METHODS: A framework synthesis was conducted, incorporating relevant theory, key informant interviews (n = 37) and a scoping review. Thematic analysis informed the development of a framework for understanding and influencing political priority for alcohol policy. RESULTS: Twelve barriers and 14 strategies were identified at multiple levels (global, national and local). Major barriers included neoliberal or free trade ideology, the globalised alcohol industry, limited advocate capacity and the normalisation of alcohol harms. Strategies fell into two categories: sector-specific and system change initiatives. Sector-specific strategies primarily focus on influencing policymakers and mobilising civil society. Examples include developing a clear, unified solution, coalition building and effective framing. System change initiatives target structural change to reduce the power imbalance between industry and civil society, such as restricting industry involvement in policymaking and securing sustainable funding for advocacy. A key example is establishing an international treaty, similar to the Framework Convention on Tobacco Control, to support domestic policymaking. DISCUSSION AND CONCLUSIONS: Our findings provide a framework for understanding and advancing political priority for alcohol policy. The framework highlights that progress can be achieved at various levels and through diverse groups of actors. The importance of upstream drivers of policymaking was a key finding, presenting challenges for time-poor advocates, but offering potential facilitation through effective global leadership.

Foetal alcohol spectrum disorder in Aotearoa, New Zealand: Estimates of prevalence and indications of inequity.

INTRODUCTION: Foetal alcohol spectrum disorder (FASD) is 100% caused by alcohol. The lifelong disability caused by prenatal alcohol exposure cannot be reversed. Lack of reliable national prevalence estimates of FASD is common internationally and true of Aotearoa, New Zealand. This study modelled the national prevalence of FASD and differences by ethnicity. METHODS: FASD prevalence was estimated from self-reported data on any alcohol use during pregnancy for 2012/2013 and 2018/2019, combined with risk estimates for FASD from a meta-analysis of case-ascertainment or clinic-based studies in seven other countries. A sensitivity analysis using four more recent active case ascertainment studies was performed to account for the possibility of underestimation. RESULTS: We estimated FASD prevalence in the general population to be 1.7% (95% confidence interval [CI] 1.0%; 2.7%) in the 2012/2013 year. For Maori, the prevalence was significantly higher than for Pasifika and Asian populations. In the 2018/2019 year, FASD prevalence was 1.3% (95% CI 0.9%; 1.9%). For Maori, the prevalence was significantly higher than for Pasifika and Asian populations. The sensitivity analysis estimated the prevalence of FASD in the 2018/2019 year to range between 1.1% and 3.9% and for Maori, from 1.7% to 6.3%. DISCUSSION AND CONCLUSIONS: This study used methodology from comparative risk assessments, using the best available national data. These findings are probably underestimates but indicate a disproportionate experience of FASD by Maori compared with some ethnicities. The findings support the need for policy and prevention initiatives to support alcohol-free pregnancies to reduce lifelong disability caused by prenatal alcohol exposure.

Changes in the incidence of assault after restrictions on late-night alcohol sales in New Zealand: evaluation of a natural experiment using hospitalization and police data.

AIMS: To estimate the effect of national restrictions on late-night availability of alcohol on alcohol-related assault at a population level as indicated by (1) change in hospitalizations for weekend assaults and (2) change in the proportion of assaults documented by police that occur at night. DESIGN: Evaluation of a natural experiment, involving: (1) pre-post comparisons of age-specific incidence rates, adjusted for seasonality and background trend using Poisson regression; and (2) interrupted time-series analyses, using seasonal autoregressive integrated moving average (SARIMA) models of national data with no control site. SETTING: New Zealand. PARTICIPANTS: (1) Inpatients discharged from NZ hospitals following assault during the weekend (Friday-Sunday) from 2004 to 2016 (n = 14 996) and (2) cases of assault recorded by NZ Police from 2012 to 2018. INTERVENTION: introduction of national maximum trading hours for all on-licence (8 a.m.-4 a.m.) and off-licence premises (7 a.m.-11 p.m.), abolishing existing 24-hour licences, on 18 December 2013. MEASUREMENTS: (1) Age-specific incidence of hospitalization for assault on Friday, Saturday or Sunday from the national hospital discharge data set, excluding short-stay emergency department admissions and (2) proportion of weekly police-documented assaults occurring between 9 p.m. and 5.59 a.m., from NZ Police Demand and Activity data set. FINDINGS: Following the restrictions, weekend hospitalized assaults declined by 11% [incidence rate ratio (IRR) = 0.89; 95% confidence interval (CI) = 0.84, 0.94], with the greatest reduction among 15-29-year-olds (IRR = 0.82; 95% CI = 0.76, 0.89). There was an absolute reduction (step change) of 1.8% (95% CI = 0.2, 3.5%) in the proportion of police-documented assaults occurring at night, equivalent to 9.70 (95% CI = 0.10, 19.30) fewer night-time assaults per week, out of 207.4. CONCLUSIONS: The 2013 implementation of national maximum trading hours for alcohol in NZ was followed by reductions in two complementary indicators of alcohol-related assault, consistent with beneficial effects of modest nation-wide restrictions on the late-night availability of alcohol.

Older Drivers and Their Future Mobility: Views and Involvement of Their Adult Children.

In car-dependent societies like New Zealand, getting the right balance between mobility and safety could improve outcomes for older people but will require changes to policy and practice. Driving cessation is a major life transition with many impacts, and adult children are frequently involved in both the transition to non-driving and maintaining mobility afterward. This cross-sectional study (N = 675) sought perspectives of family members of drivers aged 65 or older enrolled in a longitudinal study. Most (94%) were adult children, two thirds were women, and 19% were moderately to extremely anxious about their parent's driving. Loss of independence, driving's role in identity, and reluctance to rely on family were recognized as important barriers to driving cessation. Most (80%) felt that families, as well as older drivers, would be adversely affected by driving cessation. Families identified accessible local information and services, alternative transport, and community-based programs for drivers and families as assistance most needed.

Chlamydia Testing in New Zealand: Analysis of the 2014/2015 National Health Survey.

BACKGROUND: Diagnosis rates of Chlamydia trachomatis are high in New Zealand; 1.3% of men and 3.7% of women aged 15 to 29 years were diagnosed in 2016. Because testing rates are also higher in women, we sought to understand chlamydia testing by demographic and behavioral characteristics. METHODS: Chlamydia testing in the past year, sexual behavior, and demographic characteristics were reported in the population-based 2014/2015 New Zealand Health Survey. Those aged 16 to 44 years who had a sexual partner in the past year were included. Testing prevalence was calculated, and associations were modeled. RESULTS: A total of 1677 men and 2323 women participated (89% response rate). Of these, 5.6% (95% confidence interval, 4.3%-7.2%) of men and 16.6% (14.7%-18.7%) of women were tested in the past year. Likelihood of testing in men was associated with having multiple partners and any condomless sex (adjusted relative risk, 11.93; 95% confidence interval, 5.70-24.98) and multiple partners with consistent condom use (3.77, 1.40-10.15) compared with one sexual partner and consistent condom use, and with Maori ethnicity (1.87, 1.05-3.31) compared with European/other. Among women, testing was associated with multiple partners with and without condomless sex (3.61 [2.69-4.85] and 2.81 [1.95-4.05], respectively), pregnancy (1.61, 1.18-2.18), and Asian ethnicity (0.52, 0.30-0.89). CONCLUSIONS: The study confirms that New Zealand men are much less likely to be tested than women, a potential reason for ongoing high chlamydia incidence among both sexes. The high testing rate in women includes many at low risk, and this divergence from recommendations is another issue to address.

Prevalence of drink-driving in Thimphu, Bhutan: Targeted surveillance at sentinel sites.

INTRODUCTION AND AIMS: Bhutan has a high incidence of alcohol-related disease. With economic development, motorised transport is proliferating, increasing the potential for traffic injury. We investigated drink-driving in the country's largest urban environment. METHODS: Working with police, we set up checkpoints at major thoroughfares in Thimphu, on Tuesday, Friday and Saturday nights, from May to July 2017. Police directed cars to testing bays where drivers were breathalysed and interviewed. RESULTS: All 1596 drivers stopped by police were breathalysed, and 212 (13%) tested positive. Blood alcohol of >0.02 g/dL (which we defined as 'probable impairment') was detected in 178 drivers (11%), while 67 (4.2%) exceeded the legal limit of 0.08 g/dL. Probable impairment was more common in men, older drivers, on Tuesdays (versus Fridays or Saturdays) and later at night. CONCLUSION: Drink-driving is very common at night-time in Bhutan. Routine roadside random breath-testing, and media campaigns emphasising the risk of apprehension and consequent serious financial and social penalties, should be considered to deter drink-driving.

A polygenic score for age-at-first-birth predicts disinhibition.

BACKGROUND: A recent genome-wide association study identified molecular-genetic associations with age-at-first-birth. However, the meaning of these genetic discoveries is unclear. Drawing on evidence linking early pregnancy with disinhibitory behavior, we tested the hypothesis that genetic discoveries for age-at-first-birth predict disinhibition. METHODS: We included participants with genotype data from the two-decade-long Environmental Risk (E-Risk) Study (N = 1,999) and the four-decade-long Dunedin Study (N = 918). We calculated a genome-wide polygenic score for age-at-first-birth and tested whether it was associated with a range of disinhibitory outcomes across the life course, including low childhood self-control; risk for externalizing psychopathology; officially recorded criminal offending; substance dependence; informant reports of disinhibitory problems; and number of lifetime sexual partners. We further tested whether associations were attributable to accelerated pubertal maturation. RESULTS: In both cohorts, the age-at-first-birth polygenic score predicted low childhood self-control, externalizing psychopathology, officially recorded criminal offending, substance dependence, and number of sexual partners. Associations were modest, but robust across replication. Childhood disinhibition partly mediated associations between the polygenic score and reproductive behaviors. In contrast, associations were not attributable to accelerated pubertal timing. CONCLUSIONS: Genomic discoveries for age-at-first-birth are about more than reproductive biology: They provide insight into the disinhibitory traits and behaviors that accompany early parenthood. Age-at-first-birth is a useful proxy phenotype for researchers interested in disinhibition. Further, interventions that improve self-regulation abilities may benefit young parents and their children.

Alcohol Harms over a Period of Alcohol Policy Reform: Surveys of New Zealand College Residents in 2004 and 2014.

Background: We estimated the change in the prevalence of harms attributed by students to their drinking and to others' drinking, over a decade of concerted effort by university authorities to reduce antisocial behaviour and improve student safety. Interventions included a security and liaison service, a stricter code of conduct, challenges to liquor license applications near campus, and a ban on alcohol advertising. Methods: We used a pre-post design adjusting for population changes. We invited all students residing in colleges of a New Zealand University to complete web surveys in 2004 and 2014, using identical methods. We estimated change in the 4-week prevalence of 15 problems and harms among drinkers, and nine harms from others' drinking among all respondents. We adjusted for differences in sample sociodemographic characteristics between surveys. Results: Among drinkers there were reductions in several harms, the largest being in acts of vandalism (7.1% to 2.7%), theft (11% to 4.5%), and physical aggression (10% to 5.3%). Among all respondents (including non-drinkers), there were reductions in unwanted sexual advances (14% to 8.9%) and being the victim of sexual assault (1.0% to 0.4%). Conclusion: Alcohol-related harm, including the most serious outcomes, decreased substantially among college residents in this period of alcohol policy reform. In conjunction with evidence of reduced drinking to intoxication in this population, the findings suggest that strategies to reduce the availability and promotion of alcohol on and near campus can substantially reduce the incidence of health and social harms.

Do New Zealand communities have greater input to local alcohol policy? Population surveys before and after new legislation.

BACKGROUND: New Zealand's alcohol law reforms aimed to give communities greater control over alcohol availability. We investigated whether community participation in local liquor licensing increased and why people did not participate. METHODS: We invited 4000 randomly selected residents to complete a questionnaire in 2014 about their views on alcohol in their community, participation in local alcohol decision-making, alcohol consumption, and experience of alcohol-related harm. In 2017, we surveyed a new sample of 4000 residents, and invited the 2014 respondents to complete a follow-up questionnaire. RESULTS: Response fractions were 44% in 2014 (n = 1657) and 37% in 2017 (n = 1376) for population surveys, and 61% (n = 887) for follow-up. Cross-sectional comparisons showed no marked change in proportions reporting ever having participated in alcohol policy development (4.9% in 2014 versus 5.1% in 2017), or who objected to a licence application in the preceding year (1.0% versus 1.4%). Longitudinal comparisons also suggested little change. The most common reasons 2017 respondents gave for not participating were not knowing where to start (39%), lack of time (36%), and needing more information (32%), and this order was similar in 2014. CONCLUSION: Public participation in local liquor licencing is low and it has not increased substantially under the new legislation.

Did New Zealand's new alcohol legislation achieve its object of facilitating public input? Qualitative study of Maori communities.

BACKGROUND AND AIMS: The Treaty of Waitangi stipulates equality between Maori and non-Maori, yet Maori continue to have substantially poorer health, a driver of which is alcohol-related morbidity. In 2012, the New Zealand government introduced legislation claiming it would facilitate community input on decisions about alcohol. We investigated the experience of Maori communities with the new law. DESIGN AND METHODS: We obtained submissions made to local governments and invited a diverse range of submitters from iwi (tribes), hapu (sub-tribes/clan groups) and Maori service providers, to participate in semi-structured interviews with Maori researchers. We used template analysis to develop hypotheses, and searched for disconfirmatory evidence within interview transcripts and recordings. RESULTS: Participants had committed substantial human resources to write submissions informed by technical knowledge of liquor licensing and relevant research. They reported that local governments did not seem to engage meaningfully with the content of their submissions, and failed in many instances to update participants on how the consultation was progressing. Some observed that the alcohol industry had easier access to local politicians, and therefore expected outcomes to reflect industry interests. DISCUSSION AND CONCLUSIONS: In their response to Maori constituents on proposed alcohol policies, local governments were felt to lack the inclination or capacity to consult meaningfully. By devolving responsibility for alcohol availability while failing to compel and resource local government to give regard to treaty obligations, the new legislation risks widening existing health inequalities between Maori and non-Maori.

Hazardous Drinking among Students over a Decade of University Policy Change: Controlled Before-and-After Evaluation.

Background: Responding to high levels of alcohol-related harm among students, a New Zealand university deployed a security and liaison service, strengthened the Student Code of Conduct, increased its input on the operation of alcohol outlets near campus, and banned alcohol advertising on campus. We estimated the change in the prevalence of alcohol consumption patterns among students at the university compared with other universities. Methods: We conducted a controlled before-and-after study with surveys in residential colleges at the target university in 2004 and 2014, and in random samples of students at the target university and three control universities in 2005 and 2013. The primary outcome was the prevalence of recent intoxication, while we analysed drinking per se and drinking in selected locations to investigate mechanisms of change. Results: The 7-day prevalence of intoxication decreased from 45% in 2004 to 33% in 2014 (absolute difference: 12%; 95% CI: 7% to 17%) among students living in residential colleges, and from 40% in 2005 to 26% in 2013 (absolute difference: 14%; 95% CI: 8% to 20%) in the wider student body of the intervention university. The intervention effect estimate, representing the change at the intervention university adjusted for change at other universities (aOR = 1.30; 95% CI: 0.89 to 1.90), was consistent with a benefit of intervention but was not statistically significant (p = 0.17). Conclusion: In this period of alcohol policy reform, drinking to intoxication decreased substantially in the targeted student population. Policy reforms and coincidental environmental changes may each have contributed to these reductions.

Assessment of Non-Response Bias in Estimates of Alcohol Consumption: Applying the Continuum of Resistance Model in a General Population Survey in England.

BACKGROUND: Previous studies have shown heavier drinkers are less likely to respond to surveys and require extended efforts to recruit. This study applies the continuum of resistance model to explore how survey estimates of alcohol consumption may be affected by non-response bias in three consecutive years of a general population survey in England. METHODS: Using the Health Survey for England (HSE) survey years 2011-13, number of contact attempts (1-6 and 7+) were explored by socio-demographic and drinking characteristics. The odds of drinking more than various thresholds were modelled using logistic regression. Assuming that non-participants were similar to those who were difficult to contact (the continuum of resistance model), the effect of non-response on measures of drinking was investigated. RESULTS: In the fully-adjusted regression model, women who required 7+ calls were significantly more likely to drink more than the UK Government's recommended daily limit (OR 1.19, 95% CI 1.06-1.33, P = 0.003) and to engage in heavy episodic drinking (OR 1.23, 95% CI 1.07-1.42, P = 0.004), however this was not significant in men in the fully-adjusted model. When the continuum of resistance model was applied, there was an increase in average weekly alcohol consumption of 1.8 units among men (a 12.6% relative increase), and an increase of 1.5 units among women (a 20.5% relative increase). There was also an increase in the prevalence of heavy episodic drinking of 2.5% among men (an 12.0% relative increase) and of 2.0% among women (a 15.8% relative increase), although other measures of drinking were less affected. CONCLUSION: Overall alcohol consumption and the prevalence of heavy episodic drinking were higher among HSE participants who required more extended efforts to contact. The continuum of resistance model suggests non-response bias does affect survey estimates of alcohol consumption.